Recent diabetes management classes have been well attended, with great questions being asked by the participants. If they are interested in these questions then, hopefully you are too! Learn about peripheral neuropathy and saving money when you have diabetes.

What is peripheral neuropathy and how is it treated?

Neuropathy or nerve damage occurs in 50-70% of people with diabetes. Peripheral neuropathy involves the extremities, especially the legs and feet. There is no real cure for peripheral neuropathy but the best way to prevent or reduce the symptoms are with properly controlled blood sugars. Controlling blood pressure and not smoking in also critical. Proper and diligent foot care needs to be maintained and should include seeing a podiatrist and always keeping feet covered always with supportive shoes and breathable socks. Common symptoms include tingling, shooting and stabbing pain in the legs and feet. Changes in sensitivity and temperature are often noted and total numbness may present later. Peripheral neuropathy can lead to leg and foot weakness with loss of balance resulting in possible severe injuries. Finding relief with your physician’s help and approval can be accomplished. Although not curable, peripheral neuropathy can be treated. Some remedies are easy at home treatments including heat and cold packs. When using heat and cold packs, the general rule is 10 minutes on the area but not directly on the skin (use a wash cloth or pillow case) and 20 minutes off. Some people prefer heat treatment and others cold. It is just a personal preference.

When using heat packs, always touch them with your elbow first to prevent burns on areas of numb skin. There are OTC ointments and sprays that contain several products to relieve pain. Capsaicin(pepper) spray or ointment may relieve the pain or Lidoderm skin patches numb the area with lidocaine. OTC Biofreeze comes in a clear or green gel in a tube, roll-on or a cooling spray and temporarily numbs the area to relieve pain. There are many other OTC dermal pain relievers so check which ones work best for you. Your physician can write a prescription for physical therapy to help you develop strength and balance. They will also include stretching and strengthening exercises which can increase comfort.

Acupuncture is known to relieve peripheral neuropathy symptoms and could help symptoms. Find a licensed practitioner. There are mind/body techniques that you can easily practice at home or in a class. Think about deep breathing, visualization, meditation, yoga or Tai Chi.

Biofeedback can be an option for relief. A biofeedback machine is used with visual cues, helping you change your body’s response to pain.

Massage therapy works well to soothe the mind and the muscles. It can reduce stress, anxiety, take the tension out of the muscles and be a wonderful distraction from the pain. Add aromatherapy oils such as lavender to the experience; you are sure to be relaxed.

OTC Anti-inflammatory medications(NSAIDS) such as Ibuprofen may take the edge off the pain, at least temporarily.

If these things do not help, you can talk to your health care provider about TENS treatments. “Transcutaneous nerve stimulation”, offers, “brief pulses of electricity to nerve endings” which confuse pain signals. There are anti-depressants which can be taken short or long-term for depression and may offer some pain relief. Other medications often used for epilepsy can be prescribed for peripheral neuropathy such as Lyrica or Neurontin although they do come with side effects. In extreme cases, your doctor may prescribe an opioid pain killer such as Tramadol. There are many options to treat the pain/numbness of peripheral neuropathy but blood sugar control is the most important thing to help prevent it. Talk to your doctor for all your options.

I was not prepared for the overall expense of diabetes! All these out of pocket costs are killing me… What can I do?

It is unfortunately common news that the cost of a chronic disease such as diabetes can become easily overwhelming. Just read what is happening to patients trying to maintain their treatment with insulin. Remember, drug prices vary among local pharmacies, chain pharmacies, grocery stores and big box stores within the same geographical areas. The best way to avoid overpaying for your prescription is to do your own research. Instead of calling or running around, use websites such as Good RX, Lowest Med, or Well RX. These websites can locate the best price for you from among your local choices.

Piggy Bank Filled with MoneySee if your health care plan offers mail-order pharmacy services which allows a 3-month supply usually with cheaper prices. There are online pharmacies which may have reduced rates but without access to a pharmacist. If you choose this type of pharmacy, then know what medications you take, their actions, interactions, and side effects, in case you do not get the information from a professional. Look for a site called Legal Script to see if the online pharmacy is trustworthy and legitimate. Buy diabetes supplies from quality online sites. Look for personal customer reviews. Try to buy certain supplies in bulk to get a reduced cost. Make sure when you receive the supplies, to check expiration dates and that the supplies are in their original packaging and containers. Products like glucose tablets, lancets and glucose strips in date, can be bought in bulk. Look for diabetes management education programs that are widely covered by private insurance and Medicare. Learning to treat your diabetes day by day through education will help lower your risk of diabetes complications.

Complications can eventually cost you even more. Buy extra frozen vegetables such as whole veggies like spinach leaves, asparagus, green beans or cauliflower/broccoli and fruit when the produce is not in season or locally raised. Look for plain vegetables with no sauce and fruit in no syrup for less salt, sugar, carbohydrates and calories. Also try shopping in bulk stores such as Costco, Sam’s Club and Wal-Mart. Freeze large packages of chicken, seafood and meat for better buys. Purchase large cans or jars of unsalted mixed nuts or big bags of unsalted popcorn and place servings in individualized bags so you do not overeat. Buy big packages of low-fat cheese sticks which stay fresh for a few months. Buy bulk veggie burgers or healthy selection frozen entrée meals to keep available.

Ask your internist or endocrinologist for drug samples. Drug companies have cut back on patient samples but some offices still have sufficient stock which can be helpful as a temporary fix during the most difficult times. Talk to your doctor about changing to generic drugs. Although many new diabetes medications are not yet in generic, at least find the ones you can. Some “branded” medications do work better but you should at least try generics and check the results; you can always return to the name brand. If you are on multiple medications, see if they come in combination pills. Sometimes that is cheaper and other times taking 2 separate pills is cost beneficial – check first! Never change an existing treatment plan without checking with your health care provider.

Find coupons/cards through the manufacturers or on front desks at your physician’s office. Some diabetes/patient magazines offer coupons inside or call the manufacturer directly on their 800- phone numbers. “Patient assistance programs” help people afford drugs through the government, manufacturers and non-profits. Keep looking at your insurance plan yearly to see if you are properly insured. It is becoming more difficult but open enrollment for private insurance runs from November 1-December. Open enrollment for Medicare runs from October15-December 7th. If you find the options overwhelming, consider hiring an insurance broker. Usually the finding fee is directed to the insurance company. Even if you have straight Medicare you may need to change to an advantage plan during open enrollment. Regular Medicare requires a 20% supplement plan whereas a Medicare advantage plan does not. You may also need to consider a separate drug, dental and eye plan. Check out the difference between deductibles, what you are initially responsible for before insurance kicks in and monthly premiums which is the re-occurring monthly charge. It really depends on your present health to determine which plan will cover you the best. When checking insurance plans, also check the drug plan to see if your medications are on the formulary. Insurance plans cover medications on a tier system, tagged as 1-3. Tier 1 drugs are the ones they contract for and tier 2-3 will cost you more out of pocket. Always stay in-network with your physicians, specialists, clinics, out-patient centers and hospitals. Insurance companies “contract” for in-network facilities and will charge you more out of pocket if you go out of network. Find out if need a referral and/or an authorization to keep costs down. Check online for a list or order a hard copy from your insurance company of the providers, supplies and facilities you are entitled to for service. Join a community center or YMCA for fitness or simply walk outside. You do not need a trainer, fancy gym or classes to maintain your health. You do need self-motivation, but that is free. Consider purchasing one piece of home equipment to keep you active during inclement weather; it will be a wise investment. Check online for used home/gym equipment for best pricing. Stop spending money on a useless, expensive and dangerous habit called smoking. Save that money and apply it to good health habits and colorful fruits and vegetables.

Two questions from the practice produced some long and interesting answers. I hope you can apply this knowledge to your own life living with diabetes! Never stop trying to make the best decisions.

Have a question or comment? Then post below, no registration required. I would love to hear from you!

NOTE: Consult your Doctor first to make sure my recommendations fit your special health needs.

Roberta Kleinman

Roberta Kleinman

Roberta Kleinman, RN, M. Ed., CDE, is a registered nurse and certified diabetes educator. She grew up in Long Island, NY. Her nursing training was done at the University of Vermont where she received a B.S. R.N. Robbie obtained her Master of Education degree, with a specialty in exercise physiology, from Georgia State University in Atlanta, Georgia.

She is a member of the American Diabetes Association as well as the South Florida Association of Diabetes Educators. She worked with the education department of NBMC to help educate the hospital's in-patient nurses about diabetes. She practices a healthy lifestyle and has worked as a personal fitness trainer in the past.

She was one of the initiators of the North Broward Diabetes Center (NBMC) which started in 1990 and was one of the first American Diabetes Association (ADA) certified programs in Broward County, Florida for nearly two decades. Robbie has educated patients to care for themselves and has counseled them on healthy eating, heart disease, high lipids, use of glucometers, insulin and many other aspects of diabetes care. The NBMC Diabetes Center received the Valor Award from the American Diabetes Center for excellent care to their patients. Robbie has volunteered over the years as leader of many diabetes support groups.
Roberta Kleinman

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